Journal of Pakistan Endocrine Society

Hypocalcemia in a Young Adult: A Case of Idiopathic Hypoparathyroidism with Concurrent Vitamin-D Deficiencyn

2025-06-17T13:56:59+00:00

Introduction: Hypocalcemia is a common electrolyte disturbance with diverse etiologies, including hypoparathyroidism and vitamin D deficiency. Idiopathic hypoparathyroidism, a rare nonsurgical cause, poses diagnostic and therapeutic challenges.

Case Presentation: A 22 year-old male with no known comorbidities presented with a history of diarrhoea and occasional muscle twitching for the last 3 months. He reported a weight loss of 10 kg over a two-month period. These complaints aggravated in the last few days, which brought him under emergency care. Initial investigations revealed severe hypocalcemia (serum calcium: 5.3 mg/dL), inappropriately low parathyroid hormone (PTH: 13 pg/mL), and low activated vitamin D (1, 25-dihydroxy vitamin D: 5.96 pg/mL), suggestive of hypoparathyroidism. Intravenous calcium infusion led to symptomatic improvement. Despite extensive gastrointestinal and metabolic evaluations, no underlying cause was identified, leading to a diagnosis of idiopathic hypoparathyroidism. The patient improved with oral calcium, calcitriol, and supportive management.

Conclusion: This case underscores the importance of recognizing hypocalcemia as a potential indicator of nonsurgical hypoparathyroidism and highlights the need for a systematic diagnostic and therapeutic approach for optimal long term management.

A rare presentation of craniopharyngioma: Delayed Puberty; A case report and literature review

2025-07-10T10:04:12+00:00

Background: Craniopharyngiomas are among the most common suprasellar tumors in children and adolescents. Owing to their slow-growing and indolent nature, patients may remain asymptomatic for prolonged periods or may present with visual disturbance or headache. Delayed puberty resulting from hypopituitarism is a recognized clinical feature.
Case Report: We describe a 23-year-old male who presented with short stature and absent pubertal development. His clinical and biochemical evaluation revealed panhypopituitarism. MRI of the brain demonstrated a large suprasellar mass with radiologic features consistent with craniopharyngioma. The patient did not report headache, visual symptoms, or polyuria.
Discussion: Suprasellar masses may present with non-specific or atypical symptoms, and the absence of headache or visual disturbance does not exclude significant underlying pathology. Clinicians should maintain a high index of suspicion for hypopituitarism when evaluating individuals with unexplained short stature.
Conclusion: Early assessment of children and young adults with short stature, particularly when accompanied by lethargy, is essential to avoid delayed diagnosis of significant endocrine or structural abnormalities. For patients who decline surgical management, appropriate hormone replacement therapy can provide meaningful symptomatic improvement.

Bone Under Siege: A case of severe Skeletal Disease in Primary Hyperparathyroidism

2025-11-18T10:55:44+00:00

Primary hyperparathyroidism can lead to rare but severe bone disease. We report a 28-year-old male with chronic generalized body aches, fatigue, weight loss, difficulty walking, and painful limb movements over several months. Symptoms progressed to multiple pathological fractures of the left femur, right femoral neck, left tibia, left proximal humours, and left proximal radius and ulna, confirmed radio logically. Laboratory evaluation revealed elevated PTH and calcium with low phosphorus and vitamin D. Bone biopsy from the left tibia showed giant cell lesions consistent with osteitis fibrosa cystica. Ultrasound confirmed a parathyroid adenoma, which was surgically removed along with partial thyroidectomy. Postoperative follow-up showed normalized PTH, calcium, and vitamin D levels with complete symptom resolution. This case highlights the importance of early detection and surgical management in primary hyperparathyroidism.

Autoimmune Polyglandular Syndrome Type III: A Case Report of a Diagnostic Challenge in a Middle-Age Woman

2025-11-18T16:10:14+00:00

Introduction: Autoimmune Polyglandular Syndrome Type III (APS III) is characterized by the coexistence of autoimmune thyroid disease with other autoimmune disorders, excluding adrenal insufficiency. It remains underdiagnosed due to its variable and often non-specific clinical presentation.

Case Presentation: We report the case of a middle-aged female with a known history of autoimmune hypothyroidism who presented with symptoms of anemia and poor glycemic control. Laboratory investigations revealed positive anti-parietal cell antibodies, elevated intrinsic factor antibodies, and vitamin B12 deficiency consistent with pernicious anemia. She was also diagnosed with latent autoimmune diabetes in adults (LADA), based on positive anti-GAD antibodies and suboptimal glycemic response. These findings fulfilled the criteria for APS Type III. The patient responded well to vitamin B12 supplementation and insulin therapy, with marked improvement in hematological and metabolic parameters.

Conclusion: APS type III can manifest with non-specific or overlapping clinical features, which may contribute to delayed identification. Clinicians should maintain a high level of suspicion in patients with already diagnosed autoimmune disorders.

Content

2026-02-14T05:09:46+00:00

Vol. 2 | Issue No. 2 | July - December 2025

Glycaemic Control and Insulin requirements during pregnancy in women with Type-1 Diabetes Mellitus and Pregnancy Outcome

2025-12-04T16:07:33+00:00

Objectives: The objectives of the study are to evaluate the pattern of insulin requirements and glycaemic control throughout pregnancy in women with Type 1 diabetes mellitus, and to assess the association of maternal glycaemic control with maternal and neonatal outcomes.

Methodology: This is a Retrospective cohort study. Medical records of 135 pregnancies complicated by Type 1 diabetes mellitus (T1D) were scrutinized, and 71 medical records fulfilled the inclusion criteria. Collected data was assessed for patients’ demographics, blood glucose records, insulin requirements in each trimester, and maternal and neonatal outcomes.

Results: Average insulin requirements pre-pregnancy were 56.3 units, which peaked to 62.9 units between 6-8 weeks gestation, and between 9-13 weeks (47.1units), and a second peak between 32-36 weeks (94.4 units) and again at 38 weeks (87.4 units) onwards, the sharpest increment was observed from week 14 to week 32 Maternal complications included impaired awareness of hypoglycemia in 5.6%, ketoacidosis in 2.8%, and pregnancy-induced hypertension/pre-eclampsia in 11.3%. Premature delivery (<37 weeks) occurred in 33.8% of cases. Most births were through c-section, with an average age of 36.5 ± 2.2 weeks and a birth weight of 2425-3100 grams. The neonatal complications included neonatal hypoglycemia in 8.45%, respiratory distress syndrome in 22.54%, congenital anomalies in 11.27%, and intrauterine death (IUD) in 1.4%. There was a significant association between poor pre-pregnancy glycaemic control and congenital anomalies (p< 0.05), but there was no association between maternal glycaemic control, prematurity, neonatal hypoglycaemia, and birth weight (p=NS).

Conclusion: In pregnant women with Type 1 diabetes mellitus, insulin requirements changed with three successive changes of direction. Poor glycaemic control in T1D patients is further complicated by higher rates of maternal and neonatal complications.

Thyroid Cancer and its Relationship with pre-existing Thyroid Disease and Nodule Size: A retrospective study from a Tertiary Care Centre in Pakistan

2025-12-06T08:47:58+00:00

Objective: To determine the prevalence of thyroid cancer in patients with pre-existing thyroid diseases (particularly autoimmune thyroid disorders such as Graves’ disease) and to explore the association between nodule size and malignancy type among patients treated at a tertiary care centre in Pakistan.

Methodology: A retrospective descriptive analysis of 62 patients diagnosed with thyroid cancer between January 2015 and August 2024 was conducted. Variables included were cancer type, pre-existing thyroid condition, confirmatory diagnostic method, nodule size, recurrence, metastasis, and surgical intervention. Percentages and frequencies were calculated to identify associations and trends.

Results: Out of 62 patients, 59 (95.2%) had valid data on thyroid cancer type. Papillary thyroid carcinoma (PTC) was the most common (76.3%) followed by anaplastic carcinoma (11.9%) medullary carcinoma (6.8%) and follicular carcinoma (5.1%). Thyroid cancer was only identified in 8.1% of patients with thyroid disorder (hypothyroidism or hyperthyroidism), while 91.9% had no prior thyroid condition. Nodules between 1–3 cm accounted for nearly half of all malignancies. Recurrence and metastasis occurred in 4.8% and 19.4% patients respectively. Surgery was performed in 71% of patients.

Conclusion: This study did not find any strong association between thyroid cancer and pre-existing thyroid disease. Most malignant nodules were between 1–3 cm, highlighting the need for early and thorough evaluation of all thyroid nodules irrespective of thyroid disease history or nodule size.

Diagnostic accuracy of TI-RADS in the diagnosis of Thyroid Nodules, keeping Ultrasound-Guided FNAC as the Gold Standard

2025-12-23T08:39:53+00:00

Background: To determine the diagnostic accuracy of Thyroid Imaging Reporting and Data System (TI-RADS) in predicting thyroid malignancy using ultrasound-guided fine needle aspiration cytology (FNAC) as the gold standard.

Methodology: This retrospective cross-sectional study was conducted from August 2019 to April 2025 at the Interventional Radiology Department of Rehman Medical Institute. The study included 424 patients with thyroid nodules who underwent ultrasound evaluation using TI-RADS classification followed by ultrasound-guided FNAC. Statistical analysis was performed to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy.

Results: The overall sensitivity and specificity of TI-RADS were 54.55% and 75.79%, respectively, with PPV of 20.69% and NPV of 93.51%. The risk of malignancy for TI-RADS categories 3, 4, and 5 were 22.7%, 29.16%, and 86.66%, respectively. TI-RADS 2 demonstrated high specificity (98.2%), while TI-RADS 5 showed perfect sensitivity (100%). A significant association was found between TI-RADS scores and Bethesda classification (P < 0.001), with an area under the curve of 0.932.

Conclusion: TI-RADS is a useful tool for thyroid nodule evaluation, particularly in high-risk categories. However, the moderate overall accuracy highlights the need for larger multicenter studies to improve generalizability and reduce interobserver variability.

Correlation of Glycemic Control with Liver Fibrosis Risk (FIB-4) in Patients with Type-2 Diabetes Mellitus

2026-01-03T16:55:15+00:00

Background: Metabolic dysfunction–associated steatotic liver disease (MASLD) is highly prevalent among patients with type 2 diabetes mellitus (T2DM) and is a major risk factor for progressive liver fibrosis. Poor glycemic control may accelerate fibrogenesis, which can be assessed non-invasively using the Fibrosis-4 (FIB-4) index.

Objective: To evaluate the association between glycemic control, measured by glycated hemoglobin (HbA1c), and liver fibrosis risk as estimated by the FIB-4 score in patients with T2DM.

Methodology: This cross-sectional study included 60 adults with T2DM attending a tertiary care diabetes clinic between January 2023 and December 2024. Glycemic control was assessed using HbA1c. Liver fibrosis risk was estimated using the FIB-4 index and categorized as low (<1.3), intermediate (1.3–2.67), or high (>2.67). Differences in HbA1c across FIB-4 categories were analyzed using one-way ANOVA. Pearson correlation was used to assess the relationship between HbA1c and FIB-4 score.

Results: The mean age was 54.1 ± 9.3 years, and 55% of participants were male. Mean HbA1c was 8.4 ± 1.6%. FIB-4 risk categories were low in 46.7%, intermediate in 36.7%, and high in 16.7% of patients. HbA1c increased significantly across fibrosis categories (low: 7.6 ± 1.1%, intermediate: 8.6 ± 1.3%, high: 9.7 ± 1.4%; p < 0.001). A moderate to strong positive correlation was observed between HbA1c and FIB-4 score (r = 0.61, p < 0.001).

Conclusion: Poor glycemic control is significantly associated with higher FIB-4 scores, indicating increased risk of advanced fibrosis in patients with T2DM. Incorporation of FIB-4 assessment into routine diabetes care may facilitate early identification of patients at risk for progressive MASLD.

Psychological Distress, Glycemic Control, and Vitamin D Status in Patients with Type-2 Diabetes Mellitus from Khyber Pakhtunkhwa, Pakistan: A Cross-Sectional Study

2025-12-30T16:38:34+00:00

Background: Psychological distress is increasingly recognized as an important comorbidity in patients with type 2 diabetes mellitus (T2DM) and may adversely affect glycemic control. Emerging evidence also suggests an association between vitamin D deficiency and both metabolic dysregulation and mental health disorders; however, data from Pakistani populations remain limited.

Objective: To assess the frequency of depression, anxiety, and stress and to examine their association with glycemic control and serum vitamin D status among patients with T2DM in Khyber Pakhtunkhwa, Pakistan.

Methodology: This hospital-based cross-sectional study was conducted at the Endocrinology Department of Lady Reading Hospital, Peshawar, from December 2022 to March 2023. A total of 200 adults with T2DM aged 25–60 years were enrolled using non-probability consecutive sampling. Psychological distress was assessed using the Depression, Anxiety and Stress Scale-21 (DASS-21). Biochemical parameters included fasting blood glucose, random blood glucose, glycated hemoglobin (HbA1c), and serum 25-hydroxyvitamin D [25(OH)D] levels. Dietary vitamin D intake was evaluated using a 24-hour dietary recall. Data were analyzed using SPSS version 20. Pearson correlation and multiple linear regression analyses were applied to determine associations between psychological distress, glycemic parameters, and vitamin D levels.

Results: Participants exhibited poor glycemic control, with mean HbA1c levels of 9.59 ± 2.41% in males and 9.51 ± 1.76% in females. Mean serum vitamin D levels indicated vitamin D insufficiency in both genders (29.16 ± 5.07 ng/mL in males and 28.95 ± 4.86 ng/mL in females). Moderate to extremely severe depression, anxiety, and stress were observed in a substantial proportion of patients, with higher severity among females. HbA1c levels showed a positive association with depression and stress scores, indicating higher psychological distress with poorer glycemic control. Serum vitamin D levels demonstrated a weak inverse relationship with depression and anxiety scores, though these associations were not statistically significant.

Conclusion: Patients with T2DM demonstrated a high burden of psychological distress, suboptimal glycemic control, and vitamin D insufficiency. These findings emphasize the need for an integrated approach to diabetes management that includes routine mental health screening and nutritional assessment alongside metabolic control.

Diabetes Care and IDF Slogans: Can we change the Algorithm of Diabetes Care

2026-01-16T05:45:17+00:00